Individual
SHAYANA PRABHODANI DE SILVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1000 1ST DR NW, AUSTIN, MN 55912-2941
(507) 434-1092
(507) 434-1477
Mailing address
1000 1ST DR NW, AUSTIN, MN 55912-2941
(507) 434-1092
(507) 434-1477
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
45334
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370022552
MEDICARE RAILROAD
MN
05
—
871423100
—
MN
Enumeration date
12/07/2005
Last updated
09/28/2020
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